Antidote for metoprolol
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Antidote for Metoprolol Overdose
Introduction to Metoprolol Overdose
Metoprolol, a beta-blocker commonly used to treat high blood pressure and heart-related conditions, can lead to severe complications when overdosed. Symptoms of metoprolol overdose include bradycardia (slow heart rate), hypotension (low blood pressure), and potential cardiovascular collapse2. Effective management of metoprolol overdose is crucial to prevent fatal outcomes.
Prenalterol as an Antidote
Cardiovascular Effects of Metoprolol
In a study involving beagle dogs, metoprolol administration resulted in a significant decrease in heart rate, blood pressure, and cardiac output. The central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) increased, indicating reduced inotropic function of the heart. These changes were directly proportional to the plasma concentrations of metoprolol1.
Efficacy of Prenalterol
Prenalterol, a beta-adrenergic agonist, has shown promise as an antidote for metoprolol overdose. In the same study, prenalterol was administered intravenously to dogs that had been given high doses of metoprolol. The results demonstrated that prenalterol could reverse the effects of metoprolol on cardiac output, stroke volume, CVP, and PCWP. However, blood pressure and heart rate remained below baseline values due to the high sympathetic activity induced by anesthesia1.
Clinical Implications
The study suggests that monitoring blood pressure, CVP, PCWP, and cardiac output is essential in assessing the severity of metoprolol poisoning. Prenalterol, by exerting a pronounced inotropic effect, can effectively counteract the low cardiac output failure caused by massive doses of metoprolol. However, higher doses of prenalterol than those typically used are necessary for this reversal1.
Glucagon as an Antidote
Case Report on Metoprolol Overdose
A case report detailed the treatment of a 36-year-old male who overdosed on metoprolol. The patient consumed 15 metoprolol tablets and was brought to the emergency department. Initial treatment included gastric lavage followed by antidote therapy with glucagon2.
Role of Glucagon
Glucagon is traditionally considered a first-line antidote for beta-blocker overdose, including metoprolol. In this case, glucagon was administered to counteract the effects of the overdose. The patient was monitored for cardiac function and blood sugar levels and received psychiatric counseling and nursing care. The treatment lasted for 72 hours, highlighting the importance of comprehensive care in managing metoprolol overdose2.
Conclusion
Both prenalterol and glucagon have shown efficacy as antidotes for metoprolol overdose. Prenalterol can reverse the cardiovascular effects of metoprolol, particularly low cardiac output, while glucagon is traditionally used as a first-line treatment. Effective management of metoprolol overdose requires careful monitoring of cardiovascular parameters and appropriate antidote administration to prevent severe complications and ensure patient recovery.
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Most relevant research papers on this topic
Prenalterol as an antidote to massive doses of metoprolol--a cardiovascular study in the dog.
Prenalterol can completely reverse low cardiac output failure caused by massive doses of metoprolol, but high doses are necessary for effective treatment.
The Use of Glucagon and other Antidotes in a Case of Beta-Blocker and Calcium Channel Blocker Overdose
Intravenous glucagon and calcium chloride boluses effectively stabilized blood pressure in a case of metoprolol and nifedipine overdose, highlighting the importance of antidotes and catecholamine inotropes in managing these poisonings.
Case ReportA double-blind trial of metoprolol in acute myocardial infarction. Effects on ventricular tachyarrhythmias.
Metoprolol effectively prevents ventricular fibrillation in acute myocardial infarction patients, despite having no effect on less serious ventricular tachyarrhythmias.
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